Gangrene (cont.)

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

How can gangrene be prevented?

If tissue obtains good oxygenation by adequate arterial blood flow and does not become infected, then both dry and wet gangrene can be prevented. Consequently, avoiding tobacco use and avoiding external trauma like frostbite can help prevent gangrene. Perhaps the best way to prevent gangrene, especially in developed countries, is to keep patients with diabetes under good glucose control and to have them do frequent examinations of their feet for any signs of cuts, infection, or redness. Patients with diabetic neuropathy (for example, numbness in extremity) should do this daily.

If any wound or burn occurs, it should be treated immediately to prevent infection. This is especially important in people with diabetes, vasculitis, or a compromised immune system.

Some patients who notice coolness and redness of a local area (for example, toes, fingers) and get an angiogram that shows arterial blockage can have successful prevention of dry gangrene (and possibly wet gangrene). However, this needs to occur quickly so the vascular surgeon can remove the clot or obstruction in the artery before local tissue dies. if the vascular surgeon can remove the clot or obstruction in the artery before local tissue dies.

What is the prognosis (outlook) for a patient with gangrene?

Patients with dry gangrene usually do well as long as they do not become infected. These patients lose some local function due to tissue loss and, if they have an ongoing disease like diabetes, may develop dry gangrene again. In general, patients recover with minimal residual problems if the tissue loss is small. Patients with wet gangrene usually have a poorer prognosis than those with dry gangrene. Statistics for the U.S. suggest that the mortality (death) rate is low in patients hospitalized with gangrene. The mortality (death rate) increases if the patient becomes septic. If treatment is initiated early,some patients need some form of amputation (digits, limbs). Although the death rate has remained steady, the number of cases of gangrene has been increasing in the United States in recent years, possibly due to the increasing numbers of patients with diabetes and other diseases that affect the vascular system, but these data are not complete.